Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA 02111
www.mass.gov/masshealth
MassHealth
All Provider Bulletin 184
February 2009
TO: All Providers Participating in MassHealth
FROM: Tom Dehner, Medicaid Director
RE: NewMMIS Member Eligibility Verification System and Discontinuation of
Eligibility Operator
This bulletin applies to all providers, except dental providers who are not oral or maxillofacial surgeons.
Dental providers who are not oral or maxillofacial surgeons must contact the MassHealth Dental
Customer Service Center at 1-800-207-5019 if they have any questions about MassHealth.
Preparation for NewMMIS
What you need to do now…
ˇ Determine which staff will need access to the Provider Online Service Center and what functions they will perform.
ˇ Determine which entities should have access to your provider information within the Provider Online Service Center.
ˇ Begin to collect new member numbers.
What you should have already done…
ˇ Prepare your operations for implementation.
ˇ Establish Internet access for your staff who will use the Provider Online Service Center, if you have not done so already.
Important Dates…
ˇ March 31, 2009 – Last day for eligibility operator
Background
With the implementation of MassHealth’s new Medicaid Management Information System (NewMMIS),
you will be able to perform most MassHealth activities online 24 hours a
day, seven days a week, including eligibility verification. This bulletin
describes the changes related to member eligibility verification activities
that providers will see leading up to, and including the implementation of
NewMMIS.
Eligibility Verification System (EVS)
As part of the transition to NewMMIS, the Recipient Eligibility Verification
will be shut down and replaced by the NewMMIS
Eligibility Verification System (EVS), which will be available through the
Web-based Provider Online Service Center.
The consolidation of MassHealth’s various systems, such as REVS, into
NewMMIS will eliminate the possibility of discrepancies among systems
and will decrease the number of user ID and password combinations that
you will need to keep track of to conduct business with MassHealth.
(continued on next page)
Internet Access
To take full advantage of the benefits of the Provider Online Service
Center, including the ability to verify member eligibility, providers will need
access to the Internet. MassHealth strongly recommends that you
arrange for Internet access for all staff who will need to use the Provider
Online Service Center.
EVS Features
With EVS, providers will be able to verify member eligibility using direct
data entry (DDE) and batch submissions through a simple interface
available through the MassHealth Web site. The table below compares
the eligibility verification features of the current system (REVS) with the
features of EVS under NewMMIS.
Eligibility Verification Features
REVS Today
EVS Under NewMMIS
History
13 months of eligibility
history from the current
date of service
Search methods
Search by
* member ID
* name
* other EOHHS agency
ID (for example, IDs
beginning with ZZ, X,
or Y)
Verifying
dates of
eligibility
Verify eligibility one day at
a time.
Payment
responsibility
information
Limited information
available
Other
insurance
information
Basic insurance
information displayed
History
Up to four years of
eligibility history from the
current date of service
Search methods
Search by
* member ID
* name (expanded
searching capabilities
added)
* SSN
* other EOHHS agency
ID (for example, IDs
beginning with X or Y)
Verifying
dates of
eligibility
Verify eligibility in one-
month date ranges (except
for the Automated Voice
Response (AVR)).
Payment
responsibility
information
Expanded member
payment responsibility
displayed
Other
insurance
information
Expanded other insurance
information displayed
Elimination of Eligibility Operator
Effective April 1, 2009, the option of verifying member eligibility via the
eligibility operator option will be discontinued. The last day that the
eligibility operator will be available will be March 31, 2009.
(continued on next page)
WebREVS
With the implementation of NewMMIS, WebREVS will be replaced with
online eligibility verification through the NewMMIS Provider Online
Service Center. You will need to register to use the Provider Online
Service Center. Information about registration will be sent with the
provider PIN (personal identification number) letters and other
communications. Once NewMMIS is implemented, the user ID and
password you use for REVS will no longer be valid.
REVSpc
MassHealth is modifying REVSpc so it can support the new system
requirements for NewMMIS. Approximately 30 days before NewMMIS
implementation, MassHealth will call MassHealth providers who currently
use REVSpc to give instructions on how to download the new software.
The new software will not work in the current REVS, but you should install
it before implementation to ensure that there are no installation issues for
your organization. Due to the extent of the changes, any data in the
existing version of REVSpc will need to be updated by the provider. The
name of REVSpc will be changed to EVSpc to reflect the new version of
the software.
Automated Voice Response
MassHealth is modifying the current AVR system so that it can support
the new system requirements for NewMMIS. Unlike the Provider Online
Service Center and the EVSpc, providers using the AVR will be able to
verify only one day at a time, as they do today, due to the length of the
response on the telephone. The phone number for the AVR after
NewMMIS implementation will remain 1-800-554-0042.
Point-of-Service Devices
As described in All Provider Bulletin 178, MassHealth has discontinued
the use of point-of-sale devices.
System-to-System Verifications
Direct system communication (without manual intervention) to verify
eligibility will continue to be available, but through a new Web service
called Healthcare Transaction Service (HTS). If you currently use an
automated verification method today, call the REVS Help Desk at
1-800-462-7738 to learn about the new Web-based eligibility verification
service. This feature requires technical staff at your site who understand
how to communicate using a Web service and understand Simple Object
Access Protocol (SOAP).
(continued on back)
Access Methods
The following table compares the access methods under REVS (the
current system) with the access methods under NewMMIS.
Eligibility Verification Access Methods
REVS Today
WebREVS
REVSpc
Automated Voice Response
System
Point-of-Service (POS) devices
(discontinued)
Eligibility Operator (through March
31, 2009, only)
System-to-System Verification –
Direct communication system to
system
EVS Under NewMMIS
WebREVS will be replaced with
the Provider Online Service
Center.
Enhanced EVSpc
Enhanced Automated Voice
Response System
Enhanced features can be
accessed using the Provider
Online Service Center.
Increased search features in
NewMMIS will allow for necessary
information to be accessed using
the Provider Online Service
Center.
Healthcare Transaction Web
Service (HTS) – Direct
communication system to system
Help Desk
Upon NewMMIS implementation, the existing REVS Help Desk phone
number 1-800-462-7738 will no longer be available for use. All questions
about eligibility verification after NewMMIS implementation should be
directed to MassHealth Customer Service at 1-800-841-2900.
Questions
If you have any questions about the information in this bulletin, please
contact MassHealth Customer Service at providersupport@mahealth.net,
call 1-800-841-2900, or fax your inquiry to 617-988-8974.